Public health services are troublingly unequipped to handle the situation described in Sidin Vadukut’s ‘Bombay Fever’.

The “medical thriller” Bombay Fever begins with a Mumbai-based journalist travelling to Geneva to cover a watch exhibition, where he has an unexpected encounter with an infected Sri Lankan woman. The woman collapses and dies in his arms. The journalist returns to Mumbai with a bad cough and sparks a full blown outbreak of a disease that the world has never seen.

The novel is named after the fictitious infection (which will, one hopes, remain in the realm of fiction) whose moniker comes from the character of the journalist. Sidin Vadukut’s novel encapsulates what an outbreak really looks like – panic among the public, politicians playing down the seriousness of the situation, scientists and epidemiologists completely out of their depth. And journalists hunting for a lead.

Vadukut said that he wanted to write a medical thriller after he did some research on the global Spanish flu outbreak of 1918, which killed millions at the time. The central character of the book is Aayush Vajpayee, who is posted as a social medical officer at the time of the outbreak. His job is to combat antimicrobial resistance by interacting with all stakeholders including doctors, pharmacists, nurses, and the community at large.

The evidence given by Vajpayee to a commission formed to inquire into the government’s response to the outbreak forms the backbone of the book. While on his trips to various houses, Vajpayee stumbles on the patient zero of the outbreak in India - the journalist who is found dead in his house. The victim is found literally “melted” down, a peculiar symptom of the disease.

Vadukut brings several twists to the plot, dropping a few hints on what could have caused the outbreak to keep the reader on the edge. Is this a bug that has been identified in the past? Or is it just a drug-resistant form of an already known virus?

What goes wrong during a disease outbreak

Predictably, it takes a few weeks for authorities to get a handle on what is causing the outbreak. As the novel portrays realistically, bringing in representatives of government bodies that are supposed to swoop in during an outbreak – scientists from the National Centre of Disease Control, for instance – takes a long time. In the end, a clue to containing the outbreak comes from unexpected quarters.

The reader gets a glimpse of the worst that can happen when there is a communication breakdown. Especially when social media, such as WhatsApp, explodes with forwarded messages carrying blatantly wrong or misleading information. The impact of fake news on public health has already been witnessed. During vaccination drives for measles rubella this year, WhatsApp messages claiming it makes children impotent did the rounds.

This book presents a scenario where the harm done by seemingly helpful forwards is much worse. Just like in the novel, the government is often unable to stem the explosion of false information. Here, the chief minister herself inadvertently gives out information which is misinterpreted and leads to more deaths. Vadukut makes the valid point that hiding information from the public, or underplaying information about an outbreak, can only lead to more confusion and panic.

Sidin Vadukut

Unpredictability of medicine

In India, outbreaks of disease are frequent. Just this May, in a tribal hamlet of Andhra Pradesh, sixteen people died in three weeks of causes that are still unclear. Government officials blamed the deaths on habits such as drinking unsafe water, eating “rotten” meat and social conditions like malnutrition. The people brought this outbreak upon themselves, the officials seemed to say. While it is understandable that the real cause of deaths is sometimes very difficult to understand, there was no real attempt made to find it either. Uncomfortable possibilities, like a malaria outbreak, are dismissed.

In the book, the deadly Bombay Fever affects not just the invisible poor, but even the richer sections of the population. It is perhaps for this reason that the elected leaders are forced to take notice.

Bombay Fever effectively portrays what is already known about medicine – that it has severe limitations. A fever, cold and cough can be the symptoms of many different kinds of infections. Even if a bug is identified, often doctors may not know how it works. Medicine is sometimes guesswork, often hoping that existing drugs will cure patients. Even after bringing outbreaks under control, sometimes scientists do not know why certain measures worked. This book pays tribute to those who work in these extremely limiting conditions.

After writing his dedications, the author cautiously addresses “everyone else” and says: “This is a work of fiction, outrage accordingly.” The warning is unnecessary. The country’s public health system is in such bad shape that the sort of outbreak described in the book doesn’t seem very far fetched. Will it take a horrible outbreak of the sort described in the book for the government to take note of public health? Let us hope not.